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Summer Camp -Form Fill

Section One
Q1

Parent/Guardian Name

First Name
Q2

Parent/Guardian Name

Last Name
Q3

Parent/Guardian Email
Q4

Camper's Name

First Name
Q5

Camper's Name

Last Name
Q6

Camper's Age
Q7

Date of Birth

Date
Q8

Grade Level
Q9

School
Q10

This is a 4-week summer camp program, please choose the dates you preferred to join:
Q11

Select you preferred time (based on the days selected above)
Q12

Parent/Guardian Signature
Q13

Date Signed

Date